engleski

REGIONAL DIASTOLIC DYSFUNCTION AS EARLY MANIFESTATION OF HYPERTENSIVE HEART DISEASE

Background: Global left ventricular diastolic dysfunction measured by Doppler mitral and pulmonary veins inflow is usual in hypertensive patients. In order to understand the pathophysiological process and to diagnose subclinical myocardial changes it is necessary to assess regional diastolic function. We sought to analyze segmental myocardial relaxation using Tissue Doppler Imaging (TDI) in hypertensive patients (pts) with and without global diastolic dysfunction by conventional Doppler parameters. Methods: treated hypertensive pts (48&plusmn ; ; 7.3 yrs) with normal systolic function, and normal exercise test were divided in 2 groups according to blood pressure (BP) control from previous 24h BP monitoring. Group A: 20 pts with uncontrolled BP ; group B: 8 pts with well controled BP. Pts and 11 healthy age match normals (n.) underwent TDI (peak diastolic myocardial velocities ; E&#8217; , A&#8217; at annulus, base and middle segment (s.) of each wall in longitudinal views and basal posterior segments in short (SAX) and long axis (LAX)) and Doppler echocardiography (IVRT, PFVE, PFVA, DtE, Adur, PVA, PVAdur). For statistical analysis the non-parametric Mann-Whitney test was used. P value <0.05 &#61482; vs. control group and &#61475; vs. group B. Results: In group B parameters measured by Doppler echocardiography were normal. In contrast regional myocardial velocities obtained by TDI were: 1. all segments mean: E&#8217; /A&#8217; = 1.03 &#61617; 0.02, 2. in 4/21: in annular and basal s. of the lateral wall and basal s. in LAX or 19 % of s. mean E&#8217; /A&#8217; = 0.82&#61617; 0.07, p=0.0017&#61482; . indicated an impairment of relaxation. In group A Doppler parameters were: E/A = 0.92&#61617; 0.23&#61482; &#61475; DtE = 259&#61617; 85ms&#61482; &#61475; PVAdur/Adur = 0.82&#61617; 0.14&#61482; &#61475; indicated global diastolic dysfunction. TDI values were: 1. All segments mean: E&#8217; /A&#8217; = 0.64&#61617; 0.12, p<0.01&#61482; , p<0.05&#61475; , 2. in 18/21: in basal s. and middle s. of septum and lateral walls or 74 % of all s: mean E&#8217; /A&#8217; =0.12&#61617; 0.09, p<0.0001&#61482; &#61475; indicated impairment of relaxation in a majority of segments Conclusion: Using TDI in hypertensive pts. regional diastolic dysfunction is revealed even in the basal segments of the left ventricular wall. It is the earliest manifestation of hypertensive heart disease as it occur much earlier than global diastolic dysfunction obtained by standard Doppler parameters. These might have important clinical value in diagnosis of subclinical hypertensive heart disease and follow up of the treatment.

diastolic dysfunction; tissue Doppler echocardiography; hypertension

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